According to Harvard Business Review, trust in the US healthcare system is declining. A Gallup publication reports that only 48% of Americans rate the quality of US healthcare as "excellent" or "good."
When trust in healthcare is low, misinformation often takes the place of sound medical advice, a situation that can be fatal.
Healthcare facilities should recognize this issue and implement strategies to continuously improve the quality of care provided, which will have cascading effects for patient safety and satisfaction, as well as the all-important trust of patients and the public.
Quality improvement can help your facility with:
- Meeting regulatory requirements
- Improving patient outcomes
- Managing financial risk
In this article, you’ll find answers to common questions and practical strategies to improve the quality of care in your facility.
What is quality of care?
Quality of care refers to how well healthcare services improve health outcomes for patients and populations. It may best be understood by examining the Institute of Medicine’s framework of the 6 domains (STEEEP):
- Safe: Avoiding patient injuries
- Timely: Reducing wait time for patients
- Effective: Providing care based on scientific knowledge
- Efficient: Avoiding waste
- Equitable: Providing quality care regardless of race/ethnicity, socioeconomic status, geographic location, or gender
- Patient-centered: Ensuring the care provided reflects patient values and informed decisions
In practice, quality of care is often measured with indicators like readmission rates, infection rates, patient satisfaction scores, mortality rates, and adherence to clinical guidelines.
What are the benefits of prioritizing quality of care?
There are multiple benefits of prioritizing quality of care, for example:
- Improved individual and population health outcomes
- Reduced patient readmissions
- Consistent compliance with national standards
- High patient satisfaction
- Sustained funding from the Centers for Medicare & Medicaid Services (CMS)
- Increased trust with patients, clinicians, and the public
Additionally, high-quality care is associated with effective communication, teamwork, and favorable working conditions. All these benefits interrelate and form a culture of excellence.
Quality of care at 3 levels of healthcare
What are the levels of healthcare?
Quality of care can be split into 3 levels that indicate the complexity of medical cases, the types of conditions a physician treats, and the specialties. Those levels are identified as:
- Primary
- Secondary
- Tertiary
High-quality care has challenges and implications at each level. Let’s take a closer look.
What is primary level care?
Primary level care is usually the first contact patients have with the healthcare system. Primary health services are often the foundation for a trusting, therapeutic relationship with doctors, nurses, and the healthcare system.
Traditionally, at this level, a family doctor or a general practitioner manages cases such as:
- Common illnesses
- Minor injuries
- Screenings for common health issues
- Routine tests
- Regular physical exams and check-ups
The primary level also addresses health at a population level, for example, immunization programs, response to epidemics, or addressing health inequities and their causes.
Without high-quality primary care, minor health issues can spiral into chronic disease. Furthermore, if chronic disease management is not well coordinated, emergency room visits multiply, preventive care loses ground, and healthcare spending soars.
What is secondary level care?
The secondary level requires specialists, such as oncologists, cardiologists, gastroenterologists, urologists, and endocrinologists.
This level of healthcare is often provided in a hospital or specialized clinic with the professional and technological capacity to help patients with more severe or complex health conditions.
What is tertiary level care?
Tertiary care refers to specialized care and expertise typically requiring hospitalization and advanced equipment to resolve difficult or rare medical situations.
In some cases, tertiary care requires transferring a patient to larger metropolitan medical centers. Examples of tertiary care can include the following:
- Aortic dissections
- Advanced neonatology services
- Hemodialysis
- Coronary artery bypass
- Organ transplants
- Neurosurgery
- Severe burn treatments
High-quality tertiary care depends on clinical capabilities and non-clinical functions such as effective patient and community engagement, leadership, communication, and innovation.
Common challenges to providing quality care to patients
What challenges exist in providing quality care?
There is no shortage of challenges in healthcare. However, here are a few of the most significant obstacles to providing quality care to patients.
Fragmented care
Fragmented care is a challenge that patients, clinicians, and facilities face. Patients may see several specialists in different healthcare systems, which often leads to duplicate tests and inconsistent or differing medications that may confuse or discourage the patient.
Balancing costs with affordability
One issue impacting the quality of both secondary and tertiary healthcare is the high cost, which can lead to the postponement of needed care.
According to KFF (a health policy organization), approximately half (47%) of US adults say it is difficult to afford healthcare costs. Worse, 1 in 4 adults says they have skipped or postponed getting the healthcare they needed because of the cost within the last 12 months.
Facilities struggle to find ways to reduce costs without compromising care quality.
Aging populations and the nursing workforce demographics
It’s not only the patient population that is aging: the nursing workforce is aging right alongside it.
Reports say that since 2012, an average of 60,000 baby boomer nurses have retired each year, a number that is expected to increase, resulting in a projected 1 million total retirees by the year 2030.
As the baby boomer nurses retire, the healthcare industry faces a significant loss of experience on top of the present nursing shortage.
Healthcare staff are struggling with disengagement
Sometimes, the inherent stress in nursing becomes overwhelming due to heavier workloads.
Nurse disengagement may occur when nurses experience compassion fatigue and inadvertently show a lack of genuine caring, leading to lower-quality care and diminished patient satisfaction.
Increasing demand for healthcare services and high costs strain the system and generate stress for clinicians. This in turn, challenges healthcare quality while feeding into a cycle of nurse turnover, shortage, high nurse-to-patient ratios, more workload, nurse burnout, and more turnover.
Poor measurement
There is a systemic failure to collect, analyze, and apply the data when it comes to patient outcomes and clinical efficiency. This can create a “blind spot” for facility management and nurse leaders.
Poor measurement can happen when data is too old, not properly measured or tracked, or when healthcare facilities focus only on the volume of patients instead of the results.
Here are some examples and consequences of poor measurement:
How do nurses contribute to care quality?
Nurses shape the patient experience and quality of care through their skills, attitudes, and knowledge.
Patients often spend a lot of time with nurses whose capacity, care, and understanding build trust. The following nurse responsibilities directly impact healthcare quality.
- Communication: Listening compassionately and explaining issues the patient needs to understand
- Patient engagement: Teaching patients about their conditions, medication, and options, involving them in decisions regarding their care plan, and preparing them for discharge (readmission prevention)
- Direct patient-centered care: Providing comfort and alleviation of pain, ensuring accurate medication administration, and advocating for patients’ needs
- Organization: Ensuring coordination among the clinicians on the healthcare team
- Monitoring: Keeping carefully updated records and watching for changes in the patient's physical or emotional state, thus allowing early intervention
Nurses' dedication and expertise in patient care can save and empower lives while enhancing institutional capacity.
10 Techniques to improve quality of care at your facility
Carefully applying strategies to improve the quality of care also improves patient safety. Healthcare facilities need to transition from a culture of blame (reactive) to one of mentoring, learning, and support (proactive).
Here are 10 practical ways to enhance the quality of healthcare patients can receive at your facility:
1. Provide ongoing training and education
- Ensure staff are current with evidence-based practices—judicious integration of the best external evidence, clinical expertise, and the patient's values and expectations.
- Promote a safety culture by training in clear, open communication about safety issues without fear of punitive measures.
- Strengthen coordination with training on patient-centered care.
- Foster the practice of patient advocacy.
- Train personnel in the use of new technologies.
2. Involve and educate patients throughout their care
Clinicians need to engage patients and families as active stakeholders rather than passive recipients of treatment.
What role does patient engagement play in quality of care?
This situation ensures the patient is fully informed and educated about their care, making the process patient-centered and improving patient compliance with the care plan.
To help bridge this gap between simply ordering and a shared decision-making system, clinicians might need to:
- Teach patients: Explain their diagnosis, medications, and what they need to do to participate in their own recovery.
- Speak in simple words: Move away from dense medical jargon and use their own words.
- Conduct bedside reports: Include the patient in the handoff reports, so the patient knows what is happening and who is taking over their care for the next shift.
- Empower patients and involve them in their treatment: Give patients options when possible about their care.
3. Work with clinicians to reduce waste
Involve clinicians and personnel in understanding where inefficiencies exist and in planning strategies to reduce these types of waste:
- Medical waste: Potentially contaminated materials ranging from used needles and syringes to soiled dressings, body parts, test samples, blood, chemical substances, pharmaceuticals, medical devices, and radioactive materials
- Waste of time: Waiting in general or hunting for materials, equipment, or supplies
- Waste of equipment: Underutilized equipment due to a lack of training or damaged equipment due to improper handling
4. Maintain safe working conditions for staff
Healthcare workers can't provide high-quality care if they lack training, are overworked, or are burned out. Nurse well-being directly impacts the quality of patient care, and ensuring enough nurses on duty to cover a healthy nurse-to-patient ratio is crucial to reducing stress and increasing engagement.
Remember that your facility can reduce nurse injuries and keep nurses safe when applying safe working conditions.
5. Work with staff to improve the quality of care in nursing
Nurses who work closely with patients will have ideas for improving healthcare quality.
Your facility can benefit from consulting with nursing staff to understand what resources, support, or changes are needed to improve patient outcomes and well-being. This has the added benefit of improving nurse engagement. When nurses feel heard and become part of solutions, job satisfaction and engagement can increase.
6. Measure quality metrics to benchmark progress and success
To improve care, you need to define the right metrics for your facility type. For example, a skilled nursing facility might prioritize “fall rates”, and an acute care hospital might prioritize “catheter-associated urinary tract infections”.
Avoid asking your clinicians to be perfect. Your facility needs to set realistic benchmarks and utilize the data to identify improvement opportunities. Help clinicians interpret and share data without overwhelming them.
Compare yourself to national averages and similar facilities, and focus on a few metrics at a time.
7. Optimize staffing practices for long-term sustainability
Data shows that for every patient that increases in a nurse’s workload, the likelihood of an in-hospital death increases by 7%.
To avoid the extra workload, stress, and turnover on clinicians, healthcare facilities need to optimize their staffing capacity by adopting flexible staffing models. For example, they can optimize their nurse staffing levels by adopting:
- Internal float pools: With float pools, facilities can move nurses between units to organize nurse coverage where it’s needed.
- Per diem nurses: Platforms like Nursa allow facilities to scale up care delivery during peak demand without incurring high costs from using overtime or longer-term contingent staffing options.
8. Create a culture of safety and accountability
When a facility has a punitive culture, it creates a double-edged sword:
- Staff are more likely to hide errors, potentially impacting the patient.
- The facility never learns when there is an issue within a process that needs correcting.
Your facility can adopt a just culture, in which the question switches from “who did this?” to “how did we allow this to happen?”
In a culture of safety and accountability, transparent reporting can prevent future harm by allowing the facility to identify the root cause of the error and take steps to correct it. These steps may include staff training and reexamination and improvement of an inefficient protocol or process.
Implementing a just culture framework helps your facility to have high-impact safety protocols in place.
9. Improve transitions and discharging for patients
Approximately 20% of patients discharged experience an adverse effect within 3 weeks. Transitions are often hard for patients. But, many of these effects are preventable.
Facilities need to start discharge planning on the day that the patient is admitted, with some key elements:
- Multidisciplinary view of medications
- Follow-up appointments
- Verifying the social determinant of health for each patient
When improving transitions, facilities reduce adverse patient outcomes, reduce hospital readmission rates, and improve care.
10. Adopt a quality improvement approach
Quality improvement is an ongoing journey. The best approach to adopt quality improvement programs is to do a PDSA cycle (plan, do, study, and act):
- Plan: Identify the problem and develop a plan to solve it.
- Do: Try the solution on a small scale, for example, only in one unit or department.
- Study: Analyze if the results worked.
- Act: If it worked, roll out for the whole facility.
These ten techniques can help your facility improve patient care.
Improving care quality is an organization-wide effort
Quality of care and trust are essential to health and well-being and depend on efforts and programs to:
- Identify and address challenges
- Provide well-designed and intentional training
- Increase the involvement and engagement of nurses and doctors
- Improve patient care
Continuous quality improvement is the philosophy that most problems lie in processes, not in clinicians or other people. Learn more about the patient-centered experience, why patient safety is important, and how it improves the quality of care.
Sources:
- Harvard Business Review: 5 Steps to Restore Trust in U.S. Health Care
- Gallup: Americans Sour on U.S. Healthcare Quality
- Defining Patient Safety and Quality Care
- Table 2, [IOM’s Six Aims for Improving Health Care Quality]. - Patient Safety and Quality - NCBI Bookshelf
- KFF: Americans’ Challenges with Health Care Costs
- How Should We Prepare For The Wave Of Retiring Baby Boomer Nurses? | Health Affairs Forefront
- NIH: Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals
- AHRQ: Readmissions and Adverse Events After Discharge
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